Mail Leader for Mt. Evelyn Trail & Old Aquaduct

First Name:*		Last Name:*
Mobile Phone Number:		Home Phone Number:
Your Email:*
Previous Walking Experience:*
Emergency Contact or Next of Kin Name:*		Emergency Contact or Next of Kin Relationship:*
Emergency Contact or Next of Kin Mobile Phone Number:		Emergency Contact or Next of Kin Home Phone Number:
Emergency Contact or Next of Kin 2 Name:		Emergency Contact or Next of Kin 2 Relationship:
Emergency Contact or Next of Kin 2 Mobile Phone Number:		Emergency Contact or Next of Kin 2 Home Phone Number:
Acknowledgement of Risks and Obligations *	In voluntarily participating in activities organised by the Maroondah Bushwalking Club (the Club), described to me by the Club’s activity leaders, I am aware that my participation in these activities may expose me to risks that could lead to injury, property loss or damage. These risks include (but are not limited to) slippery or uneven surfaces, loose rocks, sunburn, pits/trenches and hyperthermia. To minimise these risks during activities I will: Ensure activities are within my capabilities. Carry snacks, lunch, 1 litre water (more in hot weather), sunscreen, personal medication, first aid kit, wear protective clothing, wear strong walking boots, and carry the appropriate equipment. Inform the activity leader if I am taking medication or have physical or other limitations that might affect my participation. Make every effort to ensure that I will remain with the rest of the party during the activity. Accept & follow instructions given by the activity leader and the nominated whip. Carry the club's Personal Emergency Information (Form M6) detailing any critical medical information and person(s) who can act on my behalf. NOTE: Bushwalking Victoria strongly recommends that all members take out personal ambulance cover with Ambulance Victoria. Having read and understood these requirements and risks, I wish to join this activity. I have considered the risks before choosing to sign this acknowledgement of risk and I accept that in signing this form I take responsibility for my actions
Verification code*	Reload